Lens Disease

China Medical University NO.4

Affiliated hospital Ophthalmology;
Ophthalmology hospital of China
Medical University
 Introduction

Lens disease:
Change of transparency
cataract
Position and morphological
abnormality
dislocation
malformation
Basic knowledge
Anatomy

Equator
Anterior capsule
Posterior capsule
Diameter:9-10mm
Thickness:4-5mm
Lens zonule
 Anatomy

Capsule: integritymaintain
transparency
Lens epi. PCO
Lens substance: lens fiber
Nucleus
Cortex
 Function

Refraction

!
Accommodation
Protection: UV filtration

What is accommodation?
The capability that eyes change
refractive condition in order to acquire
clear near sight.
 What is cataract?

Turbidity of lens

WHO: turbidity of lens + VA<0.5

What is cataract?
Case: turbid lens, but VA=0.8
 Cataract

Cataract is the No. 1 eye disease that

causing blind.
46% blindness is caused by cataract

!
 Etiology

Any factors that change the

intraocular environment to affect lens
metabolism.
Such as: ageing, mechanical, chemical,
operation, inflammation, metabolic
Malformation
Congenital factors
Risk factors

UV
Diarrhea
Malnutrition
Diabetes
Smoking
Drinking alcohol
 Classification

On etiology:
Congenital
Senile
Complicated
Metabolic
Drug induced or
toxic
Traumatic
After cataract
 Classification
On location:
Cortical
Nuclear
Subcapsular
On degree:
Immature
Intumescent
Mature
Hypermature
 Pathogenesis

The common route that causing

cataract is the oxidation injury by
peroxide free radical.

!
Apoptosishot spot of research
 Clinical manifestations
Symptoms:
Progressive vision decrease
Contrast sensitivity decrease
Refraction changes
Diplopia
Glare
Change of color sensation
Visual field defect
 contrast test

Functionality
vision
contrast
test

Positive
wave
contrast
test

CSF curve
 Vision abnormity

Color
vision
excursion

glare visual field loss

 Clinical manifestations

Signs:
Turbidity of lens
 Senile Cataract

Now called Age-related Cataract

Most commonly seen
>50 yrs old
>80 yrs old100%
Degenerative changes
 Classification

Cortical

Nuclear

Subcapsular
 Cortical cataract
4 stages
Incipient stage: wedge turbidity
 Cortical cataract

4 stages
Intumescent stage
(immature):
iris projection

Induce acute angle-

closure glaucoma
 Cortical cataract
4 stages
Mature stage
 Cortical cataract

4 stages
Hypermature stage:
Morgagni cataract
Phacoanaphylactic uveitis
Phacolytic glaucoma
Nuclear cataract
 Subcapsular cataract

Affecting vision early

 Congenital cataract

Etiology:
Hereditary
Environmental:
Virus infection
Malnutrition
Radiation
Drug
Systemic disease
VD deficiency
 Congenital cataract

Morphology
 Congenital cataract

Treatment

observation
Early operation
Amblyopia
Treatment
 Complicated cataract

Caused by other eye diseases

Corneal ulcer
Glaucoma
Uveitis
Retinal detachment
Retinitis pigmentosa
Intraocular tumor
myopia
 Kinds of Complicated cataract

Old anterior uveitis Complicated cataract

Pigmentosa eye Silicon oil eye glaucoma Complicated

cataract vogt spot
 Metabolic cataract

Caused by systemic metabolic diseases

Diabetic cataract

Galactosemia cataract

Hand-foot-twitch cataract
 Drug induced or toxic cataract

Glucocorticosteroid cataract
Chlorpromazine cataract
Miotic cataract
TNT cataract
Metal: copper, iron, mercury, silver, zinc
 Traumatic cataract

Contusive
Penetrating
Radiative
Electric
 After cataract

Now usually called PCO (posterior

capsular opacification)
Adult: 30-50%
Child: 100%
Pathogenesis:
Proliferation, migration & metaplasia of lens
epi.

!
 Treatment

Drug? NO USE
Operation: the only effective therapy
ICCE (intracapsular cataract extraction)
ECCE (extracapsular cataract extraction)
PEA (phacoemulsification)

!
 ICCE And
ECCE

ICCE ECCE
 Treatment

IOL (intraocular lens) implantation

AC and PC
Hard and foldable
 Treatment

IOL (intraocular lens) implantation

 Treatment

PEA & F-IOL

PEA & F-IOL (video)
 Treatment

Correction of aphakia:

Frame glasses
Contact lens
IOL
Laser
 Lens Dislocation

Etiology:
Congenital
Marfan syndrome
Traumatic
Spontaneous
 Clinical Manifestations
Subluxation
Dislocation
 Clinical Manifestations

Complications:
Uveitis
Secondary glaucoma
Retinal detachment
Corneal turbidity
 Trends

Photolysis of cataract

Injective IOL

Accommodative IOL